Non-compliance with a medication regimen is one of the most important problems facing patients and health care professionals. An important dimension of this non-compliance is the loss of positive medical outcome. In analyses such as the Helsinki Heart Study of over 4,000 patients, a direct correlation was found between non-compliance and unfavorable cholesterol levels. Moreover, there is virtually a linear relationship between unfavorable cholesterol levels and coronary risk. In chemotherapy, survival rates for patients who diligently maintain compliance of oral medication are markedly different compared to those who do not (50% versus 25% survival at 4 years). In the case of kidney organ transplant recipients, medical non-compliance directly affects the extent of graft loss.
On the economic side, non-compliance is dramatically expensive to the health care system. For example, 23% of United States nursing home admissions and 10% of hospital admissions are estimated to be a direct result of prescription drug non-compliance. Pro-rating this component of hospital and nursing home admissions against all other causes reveals that non-compliance leads to $45 billion of health care system utilization. Even after taking into account the incremental cost of medication in fully compliant patients, studies have shown that improving health care compliance has a cause benefit ratio as high as 14:1. Presumably, people do not set out to become non-compliant given the consequences of non-compliance. Rather, a busy life combined with normal human traits such as forgetting or denial of medical condition combine to create the phenomenon of noncompliance. While some compliance approaches to prescription medications have succeeded dramatically (e.g., birth control pill dispensers), most attempts at enforcing diligent compliance have failed.